ФУНКЦИОНАЛЬНАЯ ДОКАЗАТЕЛЬНАЯ СТОМАТОЛОГИЯ В ОСТЕОПАТИЧЕСКОЙ КОРРЕКЦИИ ДИСТАЛЬНОЙ ОККЛЮЗИИ

ФУНКЦИОНАЛЬНАЯ ДОКАЗАТЕЛЬНАЯ СТОМАТОЛОГИЯ В ОСТЕОПАТИЧЕСКОЙ КОРРЕКЦИИ ДИСТАЛЬНОЙ ОККЛЮЗИИ

Научная статья

Постников М.А.¹, Павлова О.Н.^2, *, Клочков Ф.Г.³, Гусева Е.О.⁴

¹ ORCID: 0000-0002-2232-8870;

² ORCID: 0000-0002-8055-1958;

^{1, 3} Самарский государственный медицинский университет Минздрава России, Самара, Россия;

² Самарский государственный университет путей сообщения, Самара, Россия;

⁴ Центр комплексной стоматологии, Самара, Россия

*Корреспондирующий автор (casiopeya13[at]mail.ru)

Аннотация

Дистальная окклюзия зубных рядов является одной из самых распространенных аномалий зубочелюстной системы и составляет 24,5 %-37,3 % от всех аномалий окклюзии. Цель исследования: определить эффективность комплексного ортодонтического и остеопатического лечения пациентов с дистальной окклюзией. Материалы и методы исследования: исследование проведено в клинике ООО «Центр комплексной стоматологии», г. Самара с 2019 по 2020 гг. В исследовательскую группу вошло 30 пациентов, обратившихся за ортодонтическим лечением в возрасте от 7 до 8 лет. В основной группе пациентов проводилось ортодонтическое и остеопатическое лечение (15 человек). В контрольной группе проводилось только ортодонтическое лечение (15 человек). Выводы: установлена необходимость остеопатического вмешательства на всех этапах диагностики и лечения дистальной окклюзии. Применение принципов остеопатии в ортодонтическом лечении позволяет выявить и скорректировать патологические последствия воздействия ортодонтических аппаратов на организм и адаптировать изменения зубочелюстной системы ко всей структуре тела в целом. Установлена связь зубочелюстных аномалий и ПДМ.

Ключевые слова: дистальная окклюзия, остеопатическое лечение, ортодонтическое лечение.

FUNCTIONAL EVIDENCE-BASED DENTISTRY IN OSTEOPATHIC CORRECTION OF DISTAL OCCLUSION

Research article

Postnikov M.A.¹, Pavlova O.N.², Klochkov F.G.³, Guseva E.O.⁴

¹ ORCID: 0000-0002-2232-8870;

² ORCID: 0000-0002-8055-1958;

^{1, 3} Samara State Medical University, Ministry of Healthcare of Russia, Samara, Russia;

² Samara State Railway University, Samara, Russia;

⁴ Complex Dentistry Center, Samara, Russia

* Corresponding author (casiopeya13[at]mail.ru)

Abstract

Distal occlusion is one of the most common anomalies of the dentoalveolar system and accounts for 24.5% -37.3% of all occlusion anomalies. The objective of the study is to determine the effectiveness of complex orthodontic and osteopathic treatment of distal occlusion. Materials and methods: the study was conducted in the clinic of Tsenter kompleksnoy stomatologii LLC in Samara from 2019 to 2020. The research group included 30 patients who sought orthodontic treatment in the age range of 7 to 8 years. The main group of patients underwent orthodontic and osteopathic treatment (15 people in total), while in the control group, only orthodontic treatment was performed (15 people). Conclusions: the study establishes the necessity of osteopathic intervention at all stages of diagnosis and treatment of distal occlusion. The application of the principles of osteopathy in orthodontic treatment allows for identifying and correcting the pathological consequences of the impact of orthodontic devices on the organism as well as for adapting the changes in the dentoalveolar system to the entire structure of the body. The study also establishes a link between the dentoalveolar anomalies and the primary respiratory mechanism.

Keywords: distal occlusion, osteopathic treatment, orthodontic treatment.

Distal occlusion accounts for 24.5% to 37.3% of all occlusal anomalies and is one of the most common anomalies of the maxillary system. According to the literature, the prevalence of anomalies of the dentoalveolar system increases every year, especially in children and adolescents, as they are often associated with a violation of the timing of eruption and position of permanent teeth [1], [2].

Distal occlusion is a common anomaly among both young children and adolescents, reaching 37.3% to 65% of total patients [8], [9], [10]. One of the main causes of distal occlusion formation is skeletal disproportion, leading to disharmony of the middle and lower face and impairing its aesthetics [11], [12]. Along with morphological changes in children, breathing, chewing, swallowing, and speech are impaired [8]. In children, these disorders require special attention from the orthodontist because they adversely affect the physical and psychoemotional state of adolescents.

Defects of embryonic development, hormonal disorders, excessive growth of the mandible during puberty, underdevelopment or stunting of the middle third of the face, and hereditary factors are among the main causes of bite anomalies, according to most dentists [13]. Bite anomalies are not only a problem of occlusion and dentoalveolar dysfunction, but also affect the patient's posture and mental state [14].

Occlusal anomalies can be both a cause and a consequence of musculoskeletal disorders, and the inexplicable unsuccessful orthodontic treatment, its duration, the development of complications and relapses are sometimes due to the impact on the dentoalveolar system of disorders on other organs and systems.

The expansion of ideas about the relationship between anomalies of occlusions and general disorders of the body allows us to raise the question of the need for a comprehensive study of this pathology and treatment of such patients by a number of specialists, including osteopaths.

Purpose of the study: to determine the effectiveness of complex orthodontic and osteopathic treatment of patients with distal occlusion.

Research objectives: conduct a comprehensive orthodontic and osteopathic treatment of patients with distal occlusion in the main group; compare the results of orthodontic treatment of patients in the main and control groups; establish the effect of osteopathic correction on occlusion.

Methods

The study was conducted in the clinic of the "Center of Complex Dentistry" LLC, Samara from 2019 to 2020. The study group included 30 patients who applied for orthodontic treatment at the age of 7 to 8 years. According to the random simple distribution methodology, they were divided into a main group and a control group, 15 people in each group. The parents of the children gave informed consent for their children's participation in the scientific experiment. The main group received orthodontic and osteopathic treatment. The control group received only orthodontic treatment.

All of the patients under study had a diagnosis of distal occlusion established by an orthodontist. The degree of complexity of the problem was the same. The duration of the disease was a period of alternate bite. Patients who had not previously undergone osteopathic treatment were included in the groups.

Patients with complicated chronic diseases were not included in the study groups, since these diseases can blur the clinical picture and reduce the reliability of the study. Patients who had previously undergone osteopathic treatment, had craniocerebral injuries, patients with whiplash and pronounced neurological symptoms were not included.

Each patient was examined, including: interview and examination, radiological examination consisting of an orthopantomogram (OPTG) and teleradiograph (TRG) of the head in lateral projection with transcription in Dolphin Imaging software (USA), anthropometric examination of plaster jaw models, and a photoprint.

Osteopathic examination of patients began with the collection of anamnesis according to a certain plan: general biographical data, data on living conditions, nutrition, education, as well as on working and living conditions of parents; data on hereditary burden; information on some moments of embryonic life and, finally, on the post-embryonic life of the child, relevant to the formation of the child body, breastfeeding, diseases - childhood and infectious diseases, on the state of the gastrointestinal tract, upper airways.

The osteopathic examination included determination of spheno-basilar synchondrosis (SBS) pattern; primary respiratory mechanism (PRM) parameters (rhythm, amplitude, strength) to assess liquor dynamics and vitality; cranial bone assessment, mobility; suture assessment; mutual tension membrane assessment; spine testing, sacral mobility assessment between the iliac bones.

The osteopathic diagnostic technique included: general and local listening to the patient standing and sitting, SBS diagnosis, palpatory measurement of the PDM, 4 horizontal lines test to assess symmetry of body structures, CO-C1 testing (occipital-atlanto-axial complex), and hyoid testing.

The control group of patients underwent orthodontic treatment using "CORREKTOR" elastopositioner ("Orthodont-Elit", Russia). They did not receive osteopathic treatment but underwent osteopathic testing before, during and after treatment.

Osteopathic examination of this group of patients was performed by active and passive tests. An osteopathic examination protocol was used to record pathobiomechanical abnormalities to be corrected.

The main group of patients underwent comprehensive osteopathic and orthodontic treatment using the elastopositioner "CORREACTOR".

Duration of treatment in both groups: 12 months.

All patients of the main group underwent osteopathic treatment - once every two weeks for two months, then once every three or four weeks according to an individual plan with the use of basic techniques: CV-4 fourth ventricle compression technique; venous sinus drainage technique; "frontal bone elevator"; spheno-basilar synchondrosis decompression technique; suture dysfunction elimination; cervical muscle correction techniques, hyoid release of dura mater attachments; work on craniosacral axis (sacrum, spine, skull); myofascial relaxation of masticatory muscles; technique on temporomandibular joint; on upper and lower jaw. After each session there was a balancing of the body system along the craniosacral axis.

Results

One of the most important parameters of the study is anthropometric examination of plaster models of the jaws, as it gives a true picture of the development of the upper and lower jaws.

The sum of the relative deviations from the norm before and after treatment for each child in both groups was recorded in the table of total anthropometric parameters deviations from the norm. Based on these data, the degree of approximation to the norm in the first and second groups was determined (see table 1).

 

Table 1 – Data on anthropometric parameters of patients in the main and control groups

Group	Tone Index		Width of dental rows in the area		Length of the anterior segment
	scores	norm	scores	norm	scores	norm
Before orthodontic and osteopathic treatment
1	1,31±0,04	1,33±0,03	39,1±1,25	41,5±1,49	19,3±0,68	17,3±0,55
			41,6±1,58	44,5±1,60	14,6±0,52	15,3±0,56
2	1,29±0,05	1,33±0,05	38,9±1,43	41,5±1,58	17,8±0,55	17,3±0,58
			40,2±1,37	44,5±1,56	16,6±0,56	15,3±0,44
After orthodontic treatment
1	1,30±0,04	1,33±0,05	39,0±1,25	41,5±1,62	19,1±0,73	17,3±0,61
			41,8±1,55	44,5±1,51	15,0±0,54	15,3±0,52
2	1,31±0,05	1,33±0,03	41,2±1,19	41,5±1,45	17,0±0,66	17,3±0,58
			44,0±1,58	44,5±1,65	14,8±0,45	15,3±0,54
after orthodontic and osteopathic treatment
1	1,31±0,05	1,33±0,03	40,3±1,45	41,5±1,49	16,9±0,59	17,3±0,61
			44,4±1,73	44,5±1,42	15,7±0,50	15,3±0,59
2	1,29±0,04	1,33±0,04	41,0±1,39	41,5±1,45	17,5±0,56	17,3±0,55
			44,2±1,67	44,5±1,42	15,6±0,59	15,3±0,58

  Data on osteopathic tests of patients in both groups are presented in Table 2.  

Table 2 – Data from osteopathic tests in patients

Patients No.	Tests
	Pattern SBS	PRM	Four lines	С0С1	Hyoid bone
Before orthodontic and osteopathic treatment
1	Lateral strain	6	The left shoulder is higher	+	+
2	Torsia left	7	The left shoulder is higher	+	+
After orthodontic treatment
1	Lateral strain	6	+	++	+
2	Torsia left	6	+	+	+
After osteopathic and orthodontic treatment
1	Approaching the norm	8	norm	-	-
2	norm	9	norm	-	-

 

Osteopathic testing revealed the following pathologies:

- SBS dysfunction (torsion, sidebanding, inferior vertical strein, SBS compression) in 100% of the main and control group patients;

- lesion of PRM in 100% of patients of the main and control groups;

- 4-line horizontality disorder in 100% of patients of the main and control groups;

- C0-C1 dysfunction in 85% of patients in the main and control groups;

- displacement or limitation of mobility of the hyoid bone in 85% of patients in the main and control groups.

Testing confirmed the assumption of a lesion at the level of the PRM, SBS and at the level of cranial bone mobility.

According to the data presented in the table, patients in the control group who did not receive osteopathic treatment retained or worsened the results of osteopathic testing: osteopathic lesions persisted, became more pronounced, and new ones appeared. In the main group, which received osteopathic and orthodontic treatment, 90% of the lesions revealed by testing were eliminated.

The results of the psychological tests of the patients in both groups are presented in Table 3.

 

Table 3 – Results of psychological tests of patients

Main group before treatment: - presence of headaches in 9 children (60%); - fatigue in 12 children (80%); - sleep disturbances in 4 children (26.7%); - school performance: average or above average.	Main group after treatment: - no headaches in 100%; - fatigability decreased in 100%; - sleep normalized in 100%; - school performance improved in 100%.
Control group before treatment: - The presence of headaches in 7 children (46.7%); - fatigue in 10 children (66.7%); - sleep disorders in 5 children (33.4%); - school performance: average or above average.	Control group after treatment: - presence of headaches in 12 children (80%); - fatigue in 13 children (86.7%); - sleep disturbances in 12 children (80%); - school performance: average or below average.

 

Psychological testing data indicate greater efficacy of comprehensive osteopathic and orthodontic treatment of children with dentoalveolar anomalies.

Osteopathic testing data show the urgent need for osteopathic support for patients undergoing orthodontic treatment.

Conclusion

The necessity of osteopathic intervention at all stages of diagnosis and treatment of patients with distal occlusion has been established. Application of osteopathy principles in orthodontic treatment allows to reveal and correct pathological effects of orthodontic appliances on the body and to adapt changes in the dentoalveolar system to the whole body structure. The relationship between dentoalveolar anomalies and PRM has been established.

Конфликт интересов Не указан.

Conflict of Interest None declared.

Список литературы / References

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